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Great question Sara and great points Simon.

There are a couple of studies in dogs where both drugs are used. Problem is that most involve maropitant being given and then around an hour later the apomorphine is given:

https://pubmed.ncbi.nlm.nih.gov/28042152/
https://pubmed.ncbi.nlm.nih.gov/19000276/

I think the main point is due to the timing of the drug administration and how long to peak effect. If we are giving the maropitant SC after the apomorphine, it is probably starting to work after the emetic effect of the apomorphine has passed. I think it probably has little effect.

Makes us feel better for sure.

Scott 🙂

Hello.

Thank you so much for you great questions. I wanted to start by discussing gallbladder sludge. “Sludge” in the gallbladder is defined as nonshadowing echogenic material in the gallbladder which is dependent on gravity and a commonly seen ultrasonographically during the investigation for hepatobiliary diseases. The clinical significance of this finding in small animal patients is not well established. The reported prevalence of the gallbladder “sludge” is 53- 57% in clinically healthy animals. Bromel et al. (1998) showed prevalence in clinically healthy animals is not significantly different from that in patients with hepatobiliary disease or other diseases “Sludge” seems to most commonly affect Labrador retrievers, Yorkshire terriers, Miniature Schnauzers, Beagles, Cocker spaniels, Poodles, and crossbreeds. Fewer studies have been performed to investigate prevalence and significance of gallbladder “sludge” in cats, but a lower prevalence of 14% is reported. In both dogs and cats, increased age is positively correlated with the prevalence of “sludge” but sex seems to have no effect. DeMonaco et al. (2016) identified healthy dogs with gall bladder sludge remained asymptomatic for 12 months. Biliary sludge was mild in 50%, moderate in 36%, moderate to severe in 9% and severe in 5% of this population and persistent in 88% and recurrent in 10%. Furthermore, there is no correlation between increases in liver enzymes or total bilirubin and the prevalence of “sludge” in dogs. Recently, a small study reported that the detection of immobile “sludge” had a 70% sensitivity and 100% specificity for diagnosis of bactibilia. Overall, the presence of “sludge” is not necessarily clinically significant. This finding needs to be considered in combination with clinical signs and other laboratory findings.

So, I would use ursodeoxycholic acid in cases of “sludge” if there were clinical signs/biochemical changes consistent with hepatobiliary disease. It may not be necessary to use in every case where “sludge” is detected if the animal is having ultrasound for a completely unrelated reason.

SAMe is a very safe product generally and can be used long term if necessary. I will use in cases of acute hepatitis for as long as the animal is being treated for. In these cases I will use until the point of resolution. This is normally the point where all biochemical abnormalities go back to normal. I will definitely use longer term in chronic cases. This could be lifelong if required.

I would always try and confirm inflammation with biopsy and exclude infection as you have mentioned. The evidence about what drugs to use in inflammatory/immune medicate hepatitis cases is variable. Some specialists combine corticosteroids with another immunosuppressive drug (either azathioprine or cyclosporine) to enable more rapid tapering of the corticosteroid administration to every other day anti-inflammatory doses. For most, maintenance on the second drug alone was the goal. For other specialists, single agent cyclosporine twice a day was used as first-line treatment to avoid the adverse effects of corticosteroids. Cyclosporoine is tapered to once a day as soon as remission is established.

Sorry for the long answer! I hope that helps.

Scott 🙂